Provider Demographics
NPI:1952854044
Name:MATIAS, JOAO VICTOR DE OLIVEIRA (DDS)
Entity Type:Individual
Prefix:
First Name:JOAO VICTOR
Middle Name:DE OLIVEIRA
Last Name:MATIAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 COLUMBIA PIKE APT 531
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5911
Mailing Address - Country:US
Mailing Address - Phone:301-785-5335
Mailing Address - Fax:
Practice Address - Street 1:7777 N WICKHAM RD STE 4
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7978
Practice Address - Country:US
Practice Address - Phone:321-255-6303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN246411223G0001X
VA04014158601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401415860OtherVA DENTAL LICENSE
FLDN24641OtherFL DENTAL LICENSE